Histology saves the day for a patient with sarcoidosis

Imaging suggests metastatic cancer in this patient with dry cough. At what point do you refer him to palliative care?

David, an 83-year-old retired businessman, presents with a three-month history of a dry cough that occasionally affects his sleep.

Senior man cough

He denies any weight loss, haemoptysis or other associated symptoms.

David is enjoying his retirement, partakes in regular exercise and has a healthy diet.

He is planning to go on a cruise and hopes to get rid of the cough before his departure in three weeks. He is a non-smoker and occasional drinker.

His past medical history includes mild osteoarthritis of both knees and